Healthcare Provider Details

I. General information

NPI: 1972825404
Provider Name (Legal Business Name): LEON CHERONNE JAMES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 US HIGHWAY 1 S
ST AUGUSTINE FL
32086-6000
US

IV. Provider business mailing address

13479 DEVAN LEE DR E
JACKSONVILLE FL
32226-5884
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-5240
  • Fax: 904-824-3390
Mailing address:
  • Phone: 904-476-5570
  • Fax: 904-696-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: